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CE122/FR (Eng.) 25 June 1998

ORIGINAL: ENGLISH-SPANISH

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CONTENTS

Page

Opening of the Session ...5

Officers ...5

Adoption of the Agenda and Program of Meetings ...6

Committee and Subcommittee Reports ...6

Report of the Subcommittee on Planning and Programming ...6

Report of the Award Committee of the PAHO Award for Administration, 1998...7

Program Policy Matters...8

Provisional Draft of the Program Budget of the World Health Organization for the Region of the Americas for 2000-2001 ...8

Strategic and Programmatic Orientations for the Pan American Sanitary Bureau, 1999-2002...10

Population and Reproductive Health ...13

Technical Cooperation Among Countries: Pan Americanism in the 21st Century ...15

Prevention and Control of Tobacco Use...18

Health of Older Persons...20

Acquired Immunodeficiency Syndrome (AIDS) in the Americas...23

El Niño and its Impact on Health ...26

Hantavirus ...28

Vaccines and Immunization ...30

PAHO Publications Program...33

Administrative and Financial Matters ...35

Report on the Collection of Quota Contributions ...35

Financial Report of the Director and Report of the External Auditor for 1996-1997...36

PAHO Building Fund and Maintenance and Repair of PAHO-owned Buildings ...39

PAHO Field Office Buildings...40

Personnel Matters...41

Amendments to the PASB Staff Rules ...41

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CONTENTS (cont.)

Page

General Information Matters...43

Resolutions and Other Actions of the Fifty-first World Health Assembly of Interest to the PAHO Executive Committee...43

Procedural Matters ...45

Representation of the Executive Committee at the 25th Pan American Sanitary Conference, 50th Session of the WHO Regional Committee for the Americas ...45

Provisional Agenda of the 25th Pan American Sanitary Conference, 50th Session of the WHO Regional Committee for the Americas...45

Closing of the Session ...46

Resolutions and Decisions ...47

Resolutions...47

CE122.R1 Collection of Quota Contributions ...47

CE122.R2 Financial Report of the Director and Report of the External Auditor for 1996-1997...48

CE122.R3 Provisional Draft of the Program Budget of the World Health Organization for the Region of the Americas for 2000-2001 ...48

CE122.R4 Strategic and Programmatic Orientations for the Pan American Sanitary Bureau, 1999-2002...49

CE122.R5 Population and Reproductive Health ...51

CE122.R6 Prevention and Control of Tobacco Use...52

CE122.R7 PAHO Award for Administration, 1998 ...53

CE122.R8 Amendments to the Staff Rules of the Pan American Sanitary Bureau ...54

CE122.R9 Health of Older Persons...55

CE122.R10 Acquired Immunodeficiency Syndrome...57

CE122.R11 El Niño and its Impact on Health ...59

CE122.R12 Vaccines and Immunizations...61

CE122.R13 Provisional Agenda of the 25th Pan American Sanitary Conference, 50th Session of the WHO Regional Committee for the Americas ...62

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CONTENTS (cont.)

Page Decisions...63

CE122(D1) Adoption of the Agenda...63 CE122(D2) Representation of the Executive Committee at the

25th Pan American Sanitary Conference, 50th Session

of the WHO Regional Committee for the Americas...63 CE122(D3) Report of the Subcommittee on Planning and Programming. ...64 CE122(D4) Technical Cooperation Among Countries: Pan Americanism

in the Twenty-first Century ...64 CE122(D5) Hantavirus ...64 CE122(D6) PAHO Publications Program...64 CE122(D7) Statement by the Representative of the PAHO/WHO Staff

Association...64 CE122(D8) PAHO Field Office Buildings...65 CE122(D9) Resolutions and other Actions of the Fifty-first World Health

of Interest to the PAHO Executive Committee...65 Annexes

Annex A. Agenda

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FINAL REPORT

Opening of the Session

The 122nd Session of the Executive Committee was held at the Headquarters of the Pan American Health Organization on 22-25 June 1998. The session was attended by delegates of the nine Members of the Executive Committee: Antigua and Barbuda, Bahamas, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, and Paraguay. The following Member States and Observer States were represented in an observer capacity: Bolivia, Canada, Cuba, France, Jamaica, United States of America, Uruguay, Venezuela, and Spain. In addition, five intergovernmental organizations and four nongovernmental organizations were represented.

Dr. Fernando Muñoz Porras (Chile, President of the Executive Committee) opened the session and welcomed the participants.

Dr. George Alleyne (Director, PASB) added his welcome to the participants. For the benefit of newcomers he reviewed the functions and responsibilities of the Executive Committee, noting that the 122nd Session of the Committee would be particularly important, inasmuch as it would be preparatory to the Pan American Sanitary Conference, the supreme governing authority of the Organization. By highlighting key issues and resolving any discrepancies with regard to the content and wording of the resolutions, the Executive Committee would help to avoid unnecessary discussion and greatly facilitate the work of the Conference.

Officers

The Members elected to office at the Committee’s 121st Session continued to serve in their respective capacities at the 122nd Session. The officers were therefore as listed below:

President: Chile (Dr. Fernando Muñoz Porras)

Vice President: Bahamas (Dr. Merceline Dahl-Regis) Rapporteur: Paraguay (Dr. Andrés Vidovich Morales)

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Because the Delegate of Paraguay was unavoidably delayed and was not present at the opening of the session, the Committee selected Mexico (represented by Dr. Miguel Ángel Lezana) to serve as Rapporteur pro tempore.

Adoption of the Agenda and Program of Meetings (Documents CE122/1, Rev. 3, and CE122/WP/1)

The Committee adopted the provisional agenda and program of meetings prepared by the Secretariat (Decision CE122(D1)).

Committee and Subcommittee Reports

Report of the Subcommittee on Planning and Programming (Document CE122/5)

The report on the 29th and 30th Sessions of the Subcommittee on Planning and Programming was presented by Dr. Merceline Dahl-Regis, who had served as President of the Subcommittee in representation of the Bahamas at the 30th Session. At those two sessions the Subcommittee discussed nine items that were on the agenda of the Executive Committee at the 122nd Session, namely: Prevention and Control of Tobacco Use; Health of the Elderly; Hantavirus; Strategic and Programmatic Orientations for the Pan American Sanitary Bureau. 1999-2002; Technical Cooperation Among Countries: Pan Americanism in the 21st Century; Climate Change and Infections Diseases: the Implications of El Niño; Population and Reproductive Health; PAHO Publications Program; and the Provisional Draft of the Program Budget of the World Health Organization for the Region of the Americas for 2000-2001. Some of the Subcommittee's comments on these items are summarized in this report under the respective agenda items.

The Subcommittee also considered the following items, which were not taken up by the Executive Committee: Surveillance and Prevention of Foodborne Diseases; Communication and Health; Health and Tourism; Disaster Mitigation in Health Facilities; and Bioethics. Summaries of the presentations and discussions on all the above-mentioned items may be found in the final reports of the Subcommittee's 29th and 30th Sessions (Documents SPP29/FR and SPP30/FR).

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The Committee took note of the report of the Subcommittee (Decision CE122(D3)).

Report of the Award Committee of the PAHO Award for Administration, 1998 (Documents CE122/6; CE122/6, Add. I; and CE122/6, Corrig. I)

Dr. Melba Muñiz Martelón (Mexico) reported that the Award Committee of the PAHO Award for Administration, 1998, composed of the Delegates of Bahamas, Chile, and Mexico, had met on 23 June 1998 and, after a careful examination of the candidates’ qualifications, had decided to confer the award on Dr. Christine Olive Moody, of Jamaica, for her contribution to the planning, administration, and leadership of health services in Jamaica and her continuous efforts toward the development of primary health care at the regional and global levels.

She also noted that one of the candidates had not been considered because the nomination had been received after the deadline. The Award Committee recommended that the candidacy be held in abeyance for consideration in 1999, subject to the endorsement of the candidate’s government.

The Executive Committee welcomed the selection of Dr. Moody, emphasizing her pioneering work in the area of primary health care and her many contributions, not only to the scientific development of the health field, but to the training of health workers throughout the Caribbean region. The Observer for Jamaica pointed out that Dr. Moody had been a catalyst for change at the global level, as well. She had been active in the development of primary health care long before the International Conference on Primary Health Care took place in Alma-Ata and had been instrumental in shaping the declaration and the primary health care approach that had come out of that conference and that continued to guide the work of the Organization and public health professionals around the world. The representative thanked the Committee, on behalf of the people of Jamaica, for its decision to confer the award on Dr. Moody.

The Director, in response to a request from one of the delegates, said that future reports of the Award Committee would be accompanied by a brief biographical sketch of the award recipient in order to provide the Executive Committee with a better idea of the person’s background and accomplishments.

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Program Policy Matters

Provisional Draft of the Program Budget of the World Health Organization for the Region of the Americas for 2000-2001 (Document CE122/7)

Mr. Michael Usnick (Chief of Budget, PAHO) reminded the Committee that the document under consideration contained only the WHO portion of the regular program budget for the Region of the Americas for 2000-2001. The WHO portion represented approximately 33% of PAHO’s regular core program. The combined PAHO/WHO budget for that biennium would be presented to the Governing Bodies in 1999. The instructions from the Director-General of WHO had provided for no overall program growth and had called for regional budget proposals to be submitted without any cost increases with respect to the 1998-1999 program budget. Hence, the amount being requested for the Americas was $82,686,000,* which represented only a small increase over the 1996-1997 budget. In fact, the WHO portion of the PAHO budget would have increased only 3.6% in nominal terms during the period 1994-2001, which signified real reductions in programs.

Mr. Usnick recalled that at the 30th Session of the Subcommittee on Planning and Programming he had reported that the World Health Organization, in the context of constitutional reform, was considering a new budget allocation model that would drastically reduce the allocations to some regions while substantially increasing those of others. The aim was to utilize more objective, need-based criteria for establishing the allocations, which in the past had been set on the basis of history and previous practice. He reported that in May 1998 the World Health Assembly, after intense discussion and negotiation, had voted to adopt the new model. However, to help mitigate the impact on regions whose allocations would be reduced, it had limited the reductions to 3% annually over a period of six years, or three biennia. The model would then be reviewed at the Fifty-seventh World Health Assembly, to be held in May 2004.

Although WHO had not finalized the reallocations for the 2000-2001 biennium, the PAHO Secretariat expected that the Region’s allocation would be reduced by approximately $3.7 million from the 1998-1999 level of $82,686,000. The reductions for the following two biennia (2002-2003 and 2004-2005) would be approximately $8.4 million and $12.7, respectively.

The Director noted that the members of the Subcommittee on Planning and Programming had expressed considerable opposition to the proposed reallocation scheme,

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although they had endorsed the concept of allocations based on more objective and equitable criteria. The Subcommittee had recommended that the countries of the Region adopt a common position with regard to the reallocation proposal. The regional position had been that, while reform was needed, the proposed reallocation model was flawed and every effort should be made to correct the flaws, which would have resulted in a lesser reduction for the Region of the Americas. Ultimately, however, the World Health Assembly had adopted the original proposal. He believed the countries of the Region had shown a great deal of solidarity in accepting the reduction, deeming it to be in the best interests of the World Health Organization as a whole. Nevertheless, that decision would signify an overall reduction of 20% in the WHO allocation to the Americas. It might be possible to make some adjustments in the PAHO regular budget so that the final combined budget would not be greatly affected, but the reduction would nevertheless have to be taken into account in developing the budget proposal for 2000-2001.

The Executive Committee reiterated a point made by the Subcommittee at its 30th Session, namely, that the reallocation model appeared to penalize regions that had made the most progress in improving health conditions and that had demonstrated sound financial management. The Committee emphasized that all WHO Regions, but especially those that would be receiving an increase in their allocations, should be expected to utilize their resources efficiently and manage them transparently.

The observer for the United States of America renewed his country’s opposition to any increase in either the WHO budget or the PAHO budget. He said that the document presented to the Committee seemed to suggest that WHO would permit cost increases at a later stage in the budgeting process, which would not be acceptable to his government. The United States was very committed to both organizations, but it believed that it was essential to reduce their budgets in order to keep assessments at a level that countries could afford to pay. The budgets therefore needed to be better focused, with the largest proportion of resources going to the programs that were of highest priority to the Member States and reduced allocations to lower-priority areas.

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budget: identification of national priorities, identification of the priorities that required international cooperation, and, most important, identification of which of those technical cooperation needs that PAHO was best in a position to meet.

The Executive Committee adopted Resolution CE122.R3.

Strategic and Programmatic Orientations for the Pan American Sanitary Bureau, 1999-2002 (Documents CE122/8 and CE122/8, Corrig. I)

This item was introduced by Drs. Juan Manuel Sotelo and Germán Perdomo (Office of Analysis and Strategic Planning, PAHO), who outlined the proposed strategic and programmatic orientations (SPOs) and the regional goals for the 1999-2000 quadrennium, as well as some of the ways in which the Secretariat intended to apply the SPOs through its technical cooperation programs. Dr. Sotelo noted that the document had been prepared taking into account the comments of the Subcommittee on Planning and Programming and the results of national consultations carried out during the SPO development process. The Secretariat would also incorporate the comments of the Executive Committee and hoped to thus be able to present to the 25th Pan American Sanitary Conference a document that truly reflected the consensus of the Member States regarding the policy framework for strategic planning of the Secretariat’s technical cooperation in the next quadrennium.

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the current SPOs and were using them as a frame of reference. As in the previous quadrennium, the achievement of equity had been identified as the primary objective for the period 1999-2002. A set of regional goals had also been established in relation to health outputs, health determinants, and health policies and systems.

Dr. Perdomo then presented the specific goals for each of the three aforementioned areas and highlighted the principal programmatic orientations that would guide the Secretariat’s technical cooperation under the five strategic orientations: (1) health in human development, (2) health promotion and protection, (3) environmental protection and development, (4) health systems and services development, and (5) disease prevention and control. With respect to the regional goals, he noted that they reflected not only the objectives that were considered achievable, but also the commitments accepted by the countries under the global policy on health for all in the 21st century. As for the programmatic orientations, they had been adjusted to reflect the need to address both long-standing public health problems and new, emerging, and re-emerging problems. In conclusion, Dr. Perdomo said that, while the strategic and programmatic orientations were mainly intended to guide the work of the Secretariat and enable it to contribute effectively to achievement of the regional goals, it was hoped that the countries would also bear them in mind in their own programming and policy-setting.

The Executive Committee found that the document accurately reflected the recommendations made by the Subcommittee at its 30th Session, as well as the major health concerns and issues that had emanated from the national consultations. In particular, the Committee welcomed the changes made to the programmatic orientations in order to eliminate duplications and prioritize activities. It was suggested that the slides presented by Drs. Sotelo and Perdomo be incorporated into the document, as they helped to elucidate the goals and priorities for the next quadrennium. The Committee also expressed strong support for the document’s focus on equity.

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specific regard to the goal concerning use of verified core health data, one delegate underscored the need to specify how and by whom the data had been verified or, preferably, to utilize a more objective measure of data quality. Another delegate pointed out the need to include a goal relating to oral health and fluoridation.

Responding to the Committee’s comments, Dr. Sotelo emphasized that the Secretariat assigned high priority to support and promotion of technical cooperation among countries, as was evidenced by the fact that the subject had been included as a separate item on the agendas of the Governing Bodies in 1998. In relation to the regional goals, he pointed out that, although the goals in the document were stated in general terms, more specific goals had been established in areas such as immunization and control of vaccine-preventable diseases, taking into account the differences that existed within countries. Dr. Perdomo stressed that the Secretariat was fully cognizant of the need to register information at the lowest level possible in order to detect inequities. With regard to the core data, he explained that the word “verified” was intended to convey the idea that only information that was accurate and that reflected the true situation should be published. The Secretariat would try to find a more apt term.

At the request of the Director, Dr. Daniel López Acuña (Director, Division of Health Systems and Services Development) commented on the activities of the Organization in regard to health sector reform. He recalled that at the Summit of the Americas, held in Miami in 1994, the heads of State and government of the Region had established a mandate for PAHO to monitor and evaluate health sector reform processes. Consequently, the Organization had been working with other international cooperation organizations to create a system for monitoring health sector reform, and it had entered into a collaborative project with the United States Agency for International Development (USAID), under which specific goals had been formulated. Those goals could easily be adapted and incorporated into the SPOs for the next quadrennium.

The Organization had also developed a framework for monitoring and evaluation of health sector reform, aimed at enabling the countries to assess the progress, content, and, above all, the impact of health reform efforts on health services in terms of equity, quality, effectiveness, efficiency, financial sustainability, and social participation. Those five principles had been identified as the criteria for evaluation of health reform initiatives by the Special Meeting on Health Sector Reform, held in conjunction with the Directing Council in 1995.

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economic determinants that led to poor health. In order to remedy inequities, it was crucial to have accurate information that revealed where those inequities lay, and for that reason the Secretariat was emphasizing the importance of core data. With regard to the Committee’s comments on the goals listed in the document, as had been pointed out at the 30th Session of the Subcommittee and in many visits to the countries, the SPO document should not be viewed as a programming document and therefore should not contain specific targets or budget figures. Rather, it was intended to provide general orientations for the work of the Secretariat. Hence, while the goals could be refined and clarified, they should not be overly specific. Dr. Alleyne expressed his appreciation to the Member States for their valuable contributions, which had helped to produce a document that provided clear guidelines for the Organization’s program of technical cooperation in the next four years.

The Executive Committee adopted Resolution CE122.R4.

Population and Reproductive Health (Document CE122/11)

The presentation on this item was given by Ms. Carol Collado (Acting Coordinator, Program on Family Health and Population, PAHO), who outlined PAHO’s role and the approach advocated by the Organization in the area of reproductive health. As an essential part of health and human development, reproductive health was directly linked to PAHO’s mission. The framework for the Organization’s activities in this area was provided by the various policies and plans of action on population, reproductive health, family planning, and maternal mortality adopted in the past decade by the Governing Bodies. In addition, PAHO had a mandate to support and promote international decisions adopted at conferences such as the International Conference on Population and Development (ICPD), the Fourth World Conference on Women, and others. Moreover, the Organization’s global view of the Region and its long relationship with the countries and their institutions positioned it as an ideal catalyst for helping countries work toward an integrated vision of reproductive health that would promote quality of life and sustainable development.

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The approach advocated in the document was holistic, multisectoral, and oriented toward human development and social responsibility. It incorporated a biopsychosocial focus, a life-cycle approach, and a gender perspective, and it took account of cultural factors that influenced reproductive health practices. The document proposed a number of strategies and priorities to guide the countries’ activities and PAHO’s activities with the countries, and it outlined the outcomes that the Secretariat believed would result from concerted effort to improve reproductive health in the Region. Those expected outcomes included a clear policy and legislative framework that would provide guarantees for reproductive health rights; health care models that offered quality, appropriate attention, access to the underserved, and user-friendly services; reduction in indices of prevalent health problems; and a healthier, better-informed, and empowered public.

The Executive Committee welcomed the incorporation into the document of several changes recommended by the Subcommittee on Planning and Programming, notably the inclusion of case studies and examples of best practice in the area of reproductive health. Like the Subcommittee, the Committee applauded the holistic, life-cycle approach advocated in the document and its emphasis on respect for human rights, especially the rights of women in relation to reproductive health. The Committee also commended the Secretariat for recognizing that resources were limited and attempting to set priorities for addressing the many challenges in the area of reproductive health.

The importance of ensuring continued attention to reproductive health in the context of health reform was stressed. It was suggested that one way of doing so was to demonstrate the cost-effectiveness of reproductive health interventions, as well as the social returns that they could yield. Several delegates pointed out that there was a need to disseminate the amplified concept of reproductive health more widely among health care providers and the population in the countries, as well as a need to promote greater awareness of the linkage between quality of reproductive health care and health status in the various stages of life. In that connection, the necessity of attention to the reproductive health needs of children and, especially, adolescents was underscored. It was also pointed out that, at the other end of the age spectrum, the reproductive health needs of older persons might change with the development of drugs such as sildenafil (Viagra), and it was suggested that the document should perhaps include some analysis of the potential impact of this class of pharmaceuticals on reproductive health. It was also suggested that the document should give greater attention to the issue of sexual violence.

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health services. She also acknowledged the importance of considering the potential impact of drugs such as Viagra, not only on reproductive health but also on relationships between the sexes.

The Director remarked that he had not considered the implications of Viagra and similar drugs for reproductive health; however, any drug that would affect sexual function and sexual practices obviously must be taken into account in planning reproductive health services. Certainly, the matter deserved further study. He pointed out that the life-cycle approach made reproductive health an extremely broad area, which made it difficult to establish specific lines of action. He thanked the Committee for its comments, which would help the Secretariat to focus its activities and translate the ideas presented in the document into concrete programs.

The Committee adopted Resolution CE122.R5.

Technical Cooperation Among Countries: Pan Americanism in the 21st Century (Document CE122/9)

Dr. Mirta Roses (Assistant Director of PAHO) summarized the content of the document, noting that it had been revised to incorporate the comments and suggestions of the Subcommittee on Planning and Programming. The document reviewed the evolution of technical cooperation among countries (TCC) in the Region, described various modalities for cooperation between countries, examined several recent trends in TCC in the Americas, and outlined some of the challenges and prospects for the 21st century. The document also described the role that PAHO had played in promoting and facilitating TCC and defined the principles that should be upheld in TCC proposals prepared with PAHO/WHO cooperation, namely: solidarity, sovereignty, dignity, equity, capacity development, and sustainability.

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under bilateral agreements providing for long- and medium-term contributions of human and technology resources. Dr. Roses cited examples of TCC projects of each type, noting that a number of them had received catalytic support from PAHO.

In regard to the challenges in the 21st century, Dr. Roses said that, for the countries, the principal tasks would be to create national systems for the coordination of external cooperation, monitor TCC projects and document results, and develop TCC in the health field in the framework of bilateral/multilateral agreements. For cooperation agencies, the challenges would be to effectively utilize the capabilities existing in the Region in the technical cooperation they provided and to apply new TCC orientations, emphasizing the integration of technical and economic cooperation. Specific challenges for PAHO would be to maintain TCC as a major strategy in the SPOs for 1999-2002, maximize the use of collaborating centers for TCC, strengthen coordination between the United Nations and inter-American systems with regard to TCC in the health field, and develop procedures and training for the management and implementation of health-related TCC projects.

In the discussion that followed Dr. Roses’ presentation, the Executive Committee underscored the growing importance of technical cooperation between countries, especially in light of reductions in funding for official development assistance (ODA) and the resource constraints faced by international cooperation agencies, which made it necessary to identify alternatives for meeting the technical cooperation needs of the countries. The Committee also voiced strong support for the concept of technical cooperation among countries (TCC) espoused by PAHO, as opposed to technical cooperation among developing countries (TCDC). It was emphasized that all countries, regardless of their level of development, could benefit from the knowledge and experience of other countries. Various delegates described TCC initiatives between their countries and other countries in the Region. The representative of the Inter-American Association of Sanitary and Environmental Engineering (AIDIS) summarized some of the ways in which his association had collaborated with PAHO in promoting horizontal cooperation in the area of environmental health and sanitation. He also extended an invitation to the 26th annual congress of AIDIS, to be held in Lima, Peru, during the first week of November.

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recommendations; however, it was suggested that it might be further improved through the inclusion of more information on the criteria used by PAHO for approval of TCC funds and perhaps a table showing some of the types of projects that had received those funds. The Committee expressed the hope that the amount allocated in the Organization’s budget for support of TCC projects would not decline and that the funds available would be fully used.

The delegates considered that PAHO’s chief role in TCC was to serve as a catalyst and facilitator for partnerships between the countries. In that connection, several questions were asked regarding the designation of PAHO/WHO collaborating centers and the role played by those centers in promoting technical cooperation among countries. It was pointed out that the collaborating centers could make an important contribution in the effort to focus PAHO’s budget and have some technical cooperation needs met by other agencies. The key role of the PAHO/WHO Representatives in helping the countries identify opportunities for TCC was also stressed.

With regard to the role of the collaborating centers, Dr. Roses said that PAHO was attempting, through national meetings of collaborating centers and other mechanisms, to promote greater awareness of the potential and expertise of the various centers in order to encourage greater use of their resources for horizontal cooperation. She agreed on the importance of decentralizing cooperation and involving local or regional entities as partners in cooperation projects, noting that PAHO had learned a great deal about the potential of this type of cooperation from agreements it had established with regional agencies in Spain. As for the use of the TCC funds allocated in the PAHO budget, she felt that the relatively low percentage of use (60% in 1997) reflected the need for greater institutionalization of TCC mechanisms, as well as training in this area, as the Committee had pointed out. She also indicated that more information on the criteria for approval of TCC projects and a list of projects would be included in the revised version of the document.

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He agreed on the need for formalization of cooperation agreements, emphasizing that it was essential to have a formal arrangement in order to permit evaluation of cooperation projects. In fact, the existence of a formal agreement or project was one of the criteria for approval of PAHO funding for TCC projects. As for the role of the collaborating centers, he pointed out that they could not really be viewed as an alternative for the provision of technical cooperation and therefore a means of reducing the Organization’s budget. While the centers certainly enhanced technical cooperation in the Region, the development of effective networks of collaborating centers was a very costly undertaking.

The Executive Committee did not consider it necessary to adopt a resolution on this item, but took note of Dr. Roses’ report (Decision CE122(D4)).

Prevention and Control of Tobacco Use (Document CE122/12)

Dr. Enrique Madrigal (Regional Advisor on Substance Abuse, PAHO) began his presentation on PAHO’s proposed plan of action to combat tobacco use with a series of statistics illustrating the magnitude of the tobacco epidemic in the Region. He underscored the complexity of the problem, owing to the numerous interrelated determinants of tobacco use, which necessitated a comprehensive approach to tobacco control. Dr. Madrigal then described the premises and principles on which the proposed plan was based. The plan was oriented towards: (1) decreasing the prevalence of tobacco use, which was the leading preventable cause of mortality and morbidity and carried with it serious economic consequences; (2) preventing or postponing the onset of smoking and providing support for smoking cessation initiatives; (3) combining educational, legislative, regulatory and fiscal measures in a comprehensive approach to tobacco control; (4) regulating the accessibility of tobacco products; and (5) protecting nonsmokers, especially children, from tobacco smoke in the environment.

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NGOs to combat the well-organized and well-financed international tobacco industry. Cooperation between countries was also important to share best practices and minimize unintended consequences of control measures, such as the reported increases in smuggling of black market tobacco products when taxes were raised significantly.

The Executive Committee applauded the emphasis placed on educational initiatives in the context of a comprehensive, multisectoral approach to the problem, especially education targeting children and young people. The Committee also underscored the importance of efforts to promote healthy lifestyles in general, since measures aimed at controlling tobacco use and advertising had proven insufficient to address the widespread problem of tobacco use. Research on the nature of addiction and the difficulty of modifying addictive behaviors was also seen as a priority. The importance of measures aimed at discouraging smoking among physicians and other health professionals was stressed, as was the need to prohibit tobacco use in all health facilities and government buildings. The need to analyze both the successes and setbacks of countries that had implemented tobacco control measures was also emphasized.

It was pointed out that cultural and sports organizations—which had been successfully used by tobacco companies to lobby governments for exemptions to prohibitions against advertising and sponsorship—would need new strategies to assist them in securing other sponsors for their events. It was also suggested the issue of trade in tobacco be examined in the light of World Trade Organization (WTO) regulations that might be used to prevent tobacco companies from expanding their markets in the developing world. The need to disseminate information and institute measures to prevent and control the use of smokeless tobacco was highlighted by one delegate, who pointed out that such products were beginning to be promoted, especially among young people, with the false message that they were less harmful to health.

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momentum and intersectoral support to tackle the challenge of reducing tobacco use; and advocating the principles and premises outlined in the document and promoting their inclusion in national policies and programs.

Dr. Madrigal agreed on the importance of education in helping to reinforce protective factors within the family, community, and school environment, starting at a very early age. He also acknowledged the need for research and evidence-based approaches to the problem of tobacco addiction, which could be a risk factor for addiction to other substances. Responding to the specific questions raised by the delegates, he said that strong, unified leadership of tobacco control efforts seemed to be lacking in many countries and it was therefore considered advisable to appoint a national coordinator, within the health ministry, to oversee tobacco control efforts and coordinate activities among the various sectors. With respect to legislation to control tobacco products, he explained that many countries had no controls regarding the nicotine content and toxic ingredients in cigarettes; hence, both regulations and mechanisms to enforce them were needed.

The Director was pleased that so many Member States supported PAHO’s involvement in the issue of tobacco control. He pointed out that there was sometimes a tendency to play down the importance of tobacco as a public health threat, especially to children. Faced with such attitudes, organizations such as PAHO needed the kind of strong support voiced by the Committee in order to justify dedicating more time, effort, energy, and funding to the issue. He recalled that the Subcommittee on Planning and Programming had signaled the need to prioritize activities and had identified support for the development of anti-tobacco legislation and regulation of access to and advertising of tobacco products as top priorities. For that reason, the document focused heavily on the matter of legislation. In regard to the comments on the possibility of working with the WTO on tobacco control, he pointed out that PAHO, as a regional organization, had limited capacity to deal directly with WTO, although it would be very happy to participate in any joint initiatives between WHO and WTO in relation to tobacco control. Dr. Alleyne concluded by saying that, with the countries’ support, PAHO was prepared to dedicate more resources to prevention and control of tobacco use. It was also prepared to be much more aggressive in looking for extrabudgetary resources to strengthen programs and initiatives, and it would make a greater effort to promote cooperation among countries in this area.

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Health of Older Persons (Document CE122/13)

Dr. Marta Peláez (Regional Adviser on Aging and Health, PAHO) presented the proposed plan of action on aging and health, which was based on the holistic approach of the WHO Global Program on Aging. The plan sought to promote services and interventions for successful or active aging, which had become a demographic, economic, public health, and ethical imperative, given that the prospect of an extended old age was now becoming a reality for more people than ever in the Americas. Still, the needs of older adults and the development of infrastructure for an aging society were not being given the attention needed, since the majority of countries in the Region had not yet reached the point at which the impact of population aging was strongly felt. PAHO urged that policies be developed and that systems be created now to promote the health and minimize the dependency of older persons.

PAHO technical cooperation with the countries over the next four years would focus on two main objectives: improving the health of older persons and creating public spaces and opportunities for older persons to participate as agents of change. In those two areas, the emphasis would be on primary health care services, training for caregiving, community alternatives to institutional care, intergenerational programs, volunteer programs, and networks of retired people. The Organization’s specific regional strategies, which were informed by a research agenda, would emphasize (1) dissemination of information through social communication, including specific strategies for communicating messages on health and active aging and regional workshops for health educators and the media to strengthen their capacity to convey promotional messages for healthy aging; (2) development of human resources with education and training; and (3) provision of appropriate tools for advocacy at all levels of decision-making.

The Aging and Health Program would also serve as a clearinghouse for information on aging and health through an Internet site, printed materials, and audio and video materials, and it would work to strengthen the network of centers of excellence that would be active in the areas of gerontology, geriatrics, primary health care, healthy aging, and lifelong learning among older adults. To implement the plan of action, the Program would seek to build linkages with other PAHO programs; mobilize national, regional, and international resources to supplement the funds allocated to the Program; develop a network of collaborative centers with expertise in health and aging; and develop partnerships with private and public foundations.

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community- and family-based care for older persons. It was emphasized that older persons should be seen as resources, not problems or mere recipients of paternalistic programs. It was also pointed out that there was a natural synergy between the needs of children and those of older adults and that older persons could play a valuable role in helping to care for children and strengthening the family as the basic social unit.

While the Committee recognized the multifaceted nature of issues related to population aging, several delegates pointed out that the health sector should take the lead in coordinating the response to those issues. The need to integrate the efforts of community-based, nongovernmental, and private organizations with those of government programs was highlighted, as was the need to regulate the quality of services provided by private programs and facilities. Various delegates mentioned the growing trend away from institutional care and toward home-based care of the elderly, which pointed up the need for government policies to support such approaches. The importance of better training and education in the health sector to sensitize health care providers to the special needs of the older adult was also stressed.

The exchange of information was considered an important instrument for tackling the issue, as countries were at different stages in the development and implementation of their respective national frameworks. In that regard, PAHO’s vital coordinating and leadership role in collecting and disseminating information on issues relating to aging and health was emphasized. The Committee identified several areas in which information on country experiences was especially needed, including best practices in providing care for the elderly, establishment of national councils on aging, and legislation to protect older persons. It was suggested that disseminating the new paradigm on healthy aging, which viewed the elderly as active and valued contributors to society, could help remove the stigmas that had often been associated with the aging process, in addition to promoting greater intergenerational solidarity. The power of social communication in changing attitudes related to the many aspects of the issue was also noted.

The Delegate of the Bahamas expressed her country’s gratitude to PAHO for affording it the privilege of hosting the first Caribbean forum on aging and health, held in May 1998, and noted that the Caribbean Charter on Aging and Health, which had been drafted at the meeting, would be available soon.

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health issues related to older adults were relatively new to some health care providers. She thanked the delegates for sharing some of the experiences under way in their countries and said that the Secretariat would endeavor to incorporate them in the document as illustrations of the proposed actions to enhance the health and well-being of older persons.

The Director stressed that PAHO’s commitment to the issue of healthy aging was based on its concern for the family, and he pointed out that the Program on Aging and Health was located within the area of family health precisely because of PAHO’s sensitivity to this connection. He agreed that health of the elderly was a pressing concern, given the increasing longevity of populations in many countries in the Region. In that regard, he noted that for all countries in the Region, rich or poor, when people reached the age of 60, they had the same life expectancy. The implications of that fact were remarkable and, in his view, merited further discussion. He also agreed that there was a natural synergy between the needs of children and older adults, which suggested opportunities for new paths of collaboration between UNICEF and PAHO.

The Committee adopted Resolution CE122.R9.

Acquired Immunodeficiency Syndrome (AIDS) in the Americas (Document CE122/15)

Dr. Fernando Zacarías (Coordinator, Program on AIDS and Sexually Transmitted Diseases, PAHO) highlighted some of the points contained in the document. He began by presenting the most recent statistics compiled by the Joint United Nations Program on HIV/AIDS (UNAIDS) and by PAHO on rates of HIV infection, AIDS, and sexually transmitted diseases (STD) globally and in the Region of the Americas. He pointed out that the AIDS epidemic in the Region was quite heterogeneous and emphasized the need to take into account the differences in HIV/AIDS patterns in the countries in order to plan appropriate prevention and care strategies. For that reason a typology of HIV/AIDS epidemics had been developed.

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behavioral interventions, development of HIV/AIDS care models, and STD prevention and control. Dr. Zacarías described some of the issues and the activities under way in each area.

Pursuant to a request from the 40th Directing Council (1997), Dr. Zacarías also updated the Committee on developments in relation to antiretroviral (ARV) therapies and use of zidovudine (AZT) to prevent perinatal transmission. He pointed out that the new combination ARV therapies had changed the epidemiology of the disease and created a need for different models of care. However, because of their high cost, they remained inaccessible to many people in the Region. PAHO was exploring options for reducing the cost and increasing the availability of these drugs. Dr. Zacarías cautioned that ARVs should not be considered a panacea but as one element in a comprehensive continuum of care for persons living with HIV/AIDS. As for use of AZT to prevent perinatal transmission, he reported that a recent study conducted in Thailand had shown that a simplified short-term AZT treatment regime was as effective as earlier long-term treatment schemes but much less costly.

Finally, Dr. Zacarías outlined the basic elements of the new WHO strategy for the prevention and care of sexually transmitted diseases (STD.PAC), which the PAHO Program on AIDS and STDs proposed that the Member States consider adopting. The strategy was designed to focus greater attention on prevention, treatment, and control of sexually transmitted diseases, which were associated with increased risk of HIV infection and were an important public health problem in their own right. In conclusion, he mentioned several possible mechanisms for strengthening HIV/AIDS/STD prevention and control in the future, including development of partnerships at the national level, decentralization of technical expertise, financing HIV/AIDS/STD control efforts through multilateral and bilateral funding for social development projects, formation of networks for cooperation between countries, and, most important, maintenance of the technical leadership role of the health sector within the multisectoral response promoted by UNAIDS.

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The Committee applauded PAHO’s inclusion of HIV/AIDS within the broader area of STD control and voiced support for the proposed STD.PAC strategy. Several specific issues were broached in relation to the strategy. It was pointed out there was considerable opposition to condom use in some countries and that PAHO, given its prestige and position as an authoritative source of health information, could help to combat that resistance through the dissemination of messages highlighting the preventive benefits of condom use. In relation to the recommendations on screening and case-finding included in the strategy, one delegate emphasized the need to specify which STDs would be targeted by those measures, noting that, otherwise, it might appear that WHO and PAHO were advocating HIV-testing in the general population. Other delegates felt that the procedures for HIV-testing should be simplified and destigmatized in order to encourage more people to have the test and thus help reduce transmission of HIV by individuals who were unaware that they were infected. In that connection, several delegates stressed the importance of effective educational and behavioral interventions. The potential benefits of technical cooperation among countries and sharing of experiences in relation to prevention and control of HIV/AIDS were also emphasized.

With respect to the cost of treating cases of HIV infection, the need to also take into account the cost of treating tuberculosis was stressed. It was pointed out that the emergence of new drugs and therapies for HIV infection and AIDS created ethical issues and that the countries needed cooperation and guidance from PAHO to address those issues and formulate appropriate policies. Policies to protect those who might eventually participate in HIV vaccine trials were considered especially important.

The representative of the Latin American Union Against Sexually Transmitted Diseases (ULACETS) outlined some of the ways in which his organization had collaborated with PAHO, particularly in preventive and educational activities, and pledged the continued support of ULACETS in efforts to combat sexually transmitted diseases in Latin America.

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the benefits of condoms. It was well known that, when consistently and correctly used, condoms provided a high degree of protection against sexual transmission of HIV and other infectious agents. The Organization had stressed, and would continue to stress, that technical message. Finally, he thanked ULACETS for its support, noting that the joint action by PAHO and that organization exemplified effective partnership between the public health sector and the nongovernmental sector.

The Director urged the countries to bear in mind the document’s recommendations concerning building of partnerships at the national level. It was important to take advantage of every opportunity to address the problem of AIDS. As an example, he pointed out that when funding was sought for projects in the education sector, an AIDS education component could be included. In regard to the ethical issues surrounding HIV vaccine trials, he noted that, at a recent meeting of the Caribbean Community (CARICOM) health ministers, the ethics of vaccine trials had been discussed, and the Organization had offered to provide technical expertise to assist countries in thinking through the problem.

With respect to the comments on UNAIDS, he said that PAHO, as an agency within the United Nations system, had agreed to collaborate with UNAIDS. However, the Organization had always maintained that, because AIDS was essentially a health problem, the health sector should have primary responsibility in coordinating AIDS prevention and control efforts. Moreover, it had been agreed that the UNAIDS would play a facilitating role, not an operational one. Hence, if there was evidence that UNAIDS was advocating that responsibility for management of AIDS programs should rest with the prime minister’s office and not with the ministry of health, he would not hesitate to point out to the leadership of UNAIDS that, in PAHO’s view, that was not the proper approach to take.

The Executive Committee adopted Resolution CE122.R10.

El Niño and its Impact on Health (Document CE122/10)

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United States and northern Mexico would be wetter and colder than usual, with flooding in many places; in the Amazon, dryer-than-normal conditions were predicted, while higher-than usual rainfall was anticipated in the southern portion of South America. In the Andean Area, Peru and Ecuador were expected to be warmer and wetter than usual, which would make flooding likely. Based on those predictions and available data, the Organization had worked with the countries to mitigate the possible effects of El Niño.

Various studies had failed to find any conclusive evidence linking El Niño to increased transmission of several tracer diseases, including malaria, dengue, cholera, leptospirosis, and hantavirus. Nevertheless, there was ample evidence that the phenomenon had caused considerable environmental, economic, and infrastructure damage, which in turn had affected health conditions and mortality. Heavy rainfall and flooding associated with El Niño had claimed lives and destroyed or damaged homes, roads, drainage systems, sanitation and energy services, as well as the physical infrastructure of health services. On the other hand, places in which the El Niño phenomenon had led to drought had suffered crop losses and severe depletion of water supplies. Hence, while no direct correlation had been found between El Niño and increased transmission of infectious disease, the meteorological changes and environmental impacts of the phenomenon had definitely had consequences for health.

Dr. Chuit concluded by noting that, because natural phenomena such as El Niño were unpredictable and it was therefore impossible to plan exactly what to do when one occurred, it was of utmost importance to take preventive action and work to mitigate foreseeable damages.

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At the request of Dr. Chuit, Dr. Hugo Prado (Program on Emergency Preparedness and Disaster Relief, PAHO) outlined some of the actions taken by the Organization and the countries in the area of prevention and disaster mitigation and summed up the lessons that had been learned from the experience. He emphasized that the countries’ prompt response to the 1997-1998 El Niño event had unquestionably yielded results, since both morbidity and mortality had been lower than in previous El Niño years. Nevertheless, although the Organization and health officials in the countries had received timely warning of the likely consequences of El Niño, it had become apparent that even more precise warning systems were needed in order to enable the countries to prepare appropriate contingency plans and take preventive action. In addition, because the effects of El Niño had lasted much longer than expected, the health sector and other sectors had been obliged to respond on an ongoing basis over an extended period. That situation had pointed up the need for interdisciplinary, multisectoral emergency systems capable of providing a sustained response, as well as continual revision of emergency preparedness and disaster mitigation plans. The Organization would continue to assist the countries in preparing and enhancing their disaster mitigation plans. PAHO was also compiling technical reports from the countries for a regional publication on the experience and knowledge gained from the 1997-1998 El Niño phenomenon.

Also at the request of Dr. Chuit, Dr. Robert Romano (Division of Health and Environment, PAHO) responded to the questions concerning PAHO technical cooperation in the area of environmental sanitation. He explained that the flooding associated with El Niño often affected the water treatment infrastructure of a country, creating the potential for transmission of waterborne diseases. The Organization’s activities had been aimed at ensuring the availability of emergency stores of safe drinking water. To that end, PAHO had provided treatment supplies such as sodium hypochlorite tablets.

The Director added that, although the Organization’s main focus was infrastructure-strengthening and disaster mitigation and preparation, in emergency situations it did occasionally arrange for the direct provision of needed supplies.

The Executive Committee adopted Resolution CE122.R11.

Hantavirus (Document CE122/14)

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Region, the emergence of new diseases of uncertain etiology, such as AIDS, Lyme disease, and hantavirus pulmonary syndrome (HPS), was causing great concern among national health authorities.

Dr. Schmunis recalled that HPS had first been detected in 1993 in the southwestern United States and had been associated with high fatality rates. It had been presumed that most people were infected by inhaling aerosols of the dry or fresh remains of feces, urine, or saliva from infected rodents, through direct contact with the excretions or through bites from wild rodents. No specific treatment for the syndrome was available. Subsequent outbreaks had occurred in Canada in 1994 and in Argentina, Brazil, Chile, Paraguay, and Uruguay between 1995 and 1998. By March 1998, more than 400 cases had been confirmed in the Region. Based on retrospective studies, it had also been determined that hantavirus had been circulating in the Region before clinical cases were detected. Dr. Schmunis praised public health officials throughout the Region for their astute analysis in identifying and analyzing this syndrome, whose high case fatality rate (35%–60%) had caused widespread fear in affected communities.

In view of the seriousness of the situation, the 40th Directing Council had adopted a resolution (CD40.R14) in September 1997 calling on Member States to strengthen cooperation efforts and promote, through information, education, and communication activities in the community, the adoption of good environmental sanitation practices. The resolution had also requested that the Director of PAHO create a task force to issue recommendations on surveillance, diagnosis, treatment, and prevention of hantavirus infection. The task force had met in March 1998.

PAHO had provided technical assistance in various countries in response to outbreaks and had sponsored research to characterize the virus and identify the reservoir. It had also supported technical cooperation projects between countries in areas such as diagnosis, surveillance, study of rodents, production of reagents, and diagnostic training. In addition, the Organization had provided support for the production and distribution of a guide on handling hantavirus reservoir species (Métodos para trampeo e muestreo de pequeños mamíferos para estudios virológicos, jointly published by the United States (CDC), Argentina, and Chile), and it had published a technical guide to hantavirus in the Americas, prepared with the collaboration of experts from affected countries. These materials were distributed to the Executive Committee.

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care workers, and the media to promote cooperation especially at the outbreak of epidemics; and support for technology transfer and training in diagnosis and treatment of HPS. Dr. Schmunis also mentioned that support would be provided for the regional production of antigens needed for the diagnosis of hantavirus infections and for specific research in areas defined by the task force.

The Committee welcomed the emphasis on regional cooperation, given the hemisphere-wide nature of the problem. The delegates also praised PAHO’s response as an excellent example of effective and appropriate technical cooperation. At the same time, it was stressed that constant vigilance, attention to prevention and environmental sanitation, and health education and information were key to avoiding public health problems such as hantavirus.

Dr. Schmunis emphasized that PAHO had received support from many individuals and agencies in the countries. In particular, the Organization wished to thank the Centers for Disease Control and Prevention (CDC) of the United States and the Instituto de Virosis Hemorrágicas of Argentina for their valuable assistance in activities relating to prevention, diagnosis, and treatment of HPS. He emphasized that the problem of hantavirus would be ongoing and that continued surveillance and cooperation among the countries would be essential in order to combat it.

The Executive Committee did not consider it necessary to adopt a resolution on this item, but took note of the report (Decision CE122(D5)).

Vaccines and Immunization (Document CE122/16)

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Dr. de Quadros also reported that substantial progress had been made in including a wider range of vaccines in immunization programs. The vaccine against Haemophilus influenzae type B (Hib) had been introduced in Uruguay in 1994, in Chile in 1996, in Argentina in 1997, and in Peru and Colombia in 1998, and meningitis case rates had fallen sharply wherever the vaccine had been used. By 1999, it was expected that 90% of children in the Americas would be protected against the bacteria. Those efforts exemplified the priority accorded vaccination programs by governments throughout the Region.

An increasing number of countries in the Region were using the vaccine against measles, mumps, and rubella (MMR). PAHO encouraged all countries to incorporate rubella-containing vaccine into their childhood immunization programs with a view to eliminating rubella and congenital rubella syndrome (CRS) as public health problems in the Region. Similarly, the hepatitis B vaccine had been introduced in high-risk areas in a number of Latin American and Caribbean countries. As for yellow fever, cases had been reported mainly from countries in the Amazon basin, although other countries were at risk. The Organization was working with those countries to raise awareness of the importance of incorporating the yellow fever vaccine into routine immunization programs in high-risk areas.

In conclusion, Dr. de Quadros noted that a plethora of new vaccines was expected to become available in the relatively near future. He acknowledged that the new vaccines would certainly be expensive, but he urged health and political officials in the countries to consider the substantial benefits and cost-effectiveness of vaccination programs in making decisions about the financial resources to be devoted to this area.

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Dr. de Quadros agreed that rapid action was essential to interrupt the transmission of diseases such as measles in the event that imported cases were detected and reiterated the need for follow-up campaigns to ensure immunization of all susceptibles. In regard to the comments on decentralization and health sector reform, he reported that in six countries surveyed a negative impact on epidemiological surveillance had been noted, mainly because of a lack of appropriate controls at the central government level. He also pointed out that it had been suggested that vaccination coverage and surveillance indicators be used to measure the impact of decentralization and health reform. He agreed that the question of financing for recombinant and other new vaccines was of great importance. Studies of the viability of local production would be needed to determine under what conditions local private and semi-private companies could be involved in partnerships with companies in the developed world to bring down the cost of vaccines. In regard to PAHO’s revolving fund, he noted that when the idea of a such a fund had been introduced 20 years earlier, WHO had not initially supported it, but that over the years it had become clear how important the fund was to the Region’s successes in the vaccination area. With respect to financing issues and the participation of other organizations, he noted that a working group was in the process of defining the coordination mechanisms that would be needed to further work in this area.

The Director drew the Committee’s attention to the potential for importation of measles cases from Europe and encouraged health authorities in all countries of the Region to be especially vigilant after the 1998 World Cup soccer championship in France. He underscored the Region’s value as a laboratory of positive experiences in the control of infectious disease and pointed out that the efforts to eradicate polio and measles from the Americas had global applications. In regard to the impact of health sector reform on vaccination coverage, he underscored the leadership role of the ministries of health in sustaining immunization programs. He also pointed out that financing was not the most important consideration with regard to those programs. The critical aspects were how the system was organized and the responsibility of the State to ensure that activities such as immunization were carried out at the peripheral level.

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inclined to charge exorbitant prices to countries that could afford to pay. The Organization’s experience indicated that the revolving fund, on the other hand, promoted regional solidarity and helped reduce vaccine prices for everyone, which clearly benefited all countries. He urged the Member States to continue to support the revolving fund and oppose any attempt to institute a stratified system.

The Executive Committee adopted Resolution CE122.R12.

PAHO Publications Program (Document CE122/17)

Dr. Judith Navarro (Chief, Office of Publications and Editorial Services) noted that the report on the publications program was being presented to the Governing Bodies mainly to make the Member States aware of some of the activities that PAHO was carrying out in the area of information management and dissemination, in particular through its publications program. The Committee's consideration of this item was not expected to give rise to any major policy debate or resolution.

Dr. Navarro noted that information management had been a founding principle of the Organization and had remained one of its primary functions. The Strategic and Programmatic Orientations (SPOs) for 1995-1998 called for all parts of the Organization to make maximum use of information as a powerful instrument for bringing about change. In the framework of the SPOs, the Director had established four information areas in which the Bureau would work: (1) information about health status and health services in the countries and in the Region; (2) development of national health information systems; (3) corporate information; and (4) scientific, technical, and policy-related information. The publications program was concerned with the last-mentioned area.

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program was responsible for the Headquarters library, which offered a full range of traditional library services and was developing a computerized institutional memory project that would eventually provide full-text versions of all PAHO documentation.

In conclusion, Dr. Navarro said that the Pan American Sanitary Bureau, through its publications program, sought to bolster the Organization's technical cooperation with the countries by producing quality health information that was relevant, validated, and timely; expanding the reach of that information; reducing the costs of information management; and earning a return on the investment in publishing, not only in monetary terms but also through the enhancement of health throughout the Americas.

Like the Subcommittee on Planning and Programming, the Executive Committee commended the program for its extensive and effective use of new communications technology. The crucial role of accurate information for decision- and policy-making, education of health workers, and development of horizontal cooperation projects was emphasized. Several delegates noted that their governments relied on the information produced by PAHO for those purposes. It was pointed out that access to the Internet and other technologies was limited in some countries, and the need to develop intra-country mechanisms to disseminate the information—especially to remote areas and to health workers at the local level—was underscored. The Committee identified this as an important area for PAHO technical cooperation. The Committee also acknowledged the Organization’s support in helping the countries to gain access to key publications, such as the International Classification of Diseases, 10th Revision.

The Executive Committee recommended that the program increase its production and dissemination of materials in French, since increased availability of French-language information would benefit French-speakers not only in Canada and the Caribbean but also throughout the world. The Committee pointed out that some of the costs of translating materials into French might be recovered through expansion of the market for the Organization’s publications. It was also suggested that the Organization consider updating the country profiles on the Internet more frequently in order to provide a more accurate picture of health conditions, which tended to change rapidly, as well as current information on the status of health reform efforts. However, some delegates felt that more frequent updates would place too onerous a burden on the health ministries of countries with limited resources and information management capabilities.

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greater role in facilitating access to information. As for the possibility of updating the country profiles more frequently, she noted that the publications program would soon be integrating data from the Program on Health Situation Analysis (HDA) into the country information available through the PAHO Web site.

The Director pointed out that the core data produced by HDA were regularly updated and that all the countries had access to those data through the PAHO/WHO Representative Offices. He also noted that some countries were producing their own core data, which was also being incorporated into the Organization’s system. He was very pleased to know that the countries were making use of the information produced by PAHO and highlighted some of the ways in which the Organization was utilizing new technologies to make that information more readily accessible. One of the principal ways was the creation of a virtual library that would make a wide variety of health-related publications available to the Member States through the Internet. Another was the institutional memory project at the Headquarters library.

Dr. Alleyne was also pleased that the Committee had endorsed the Organization’s marketing policy for its publications. He did not share the view of those who thought that agencies such as PAHO should not sell their products. Information was a valuable resource that was costly to produce and, while the Organization would never recover all its costs, it could recover some. As for increasing the availability of information in French, the Secretariat would consider the feasibility of translating more materials into both French and Portuguese. It would be necessary first to determine which publications would be of greatest use to speakers of those languages. He encouraged the delegates to advise the Secretariat if they knew of outlets through which PAHO publications in French and Portuguese might be offered.

The Committee did not consider it necessary to adopt a resolution on this item but took note of the report (Decision CE122(D6)).

Administrative and Financial Matters

Report on the Collection of Quota Contributions (Document CE122/18 and CE122/18, Add. I)

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corresponding amount of arrears as of June 1997 had been $23 million. Mr. Matthews was pleased to report that since 12 June 1998, additional payments of $1.3 million had been received from Mexico, $60,000 from Cuba, and $15,682 from Antigua and Barbuda.

Six Member States had paid their 1998 assessments in full; eight Member States had made partial payments for 1998; and 25 Member States had not made any payments at all toward the current year assessments. Together, the collection of arrears and current year assessments during 1998 totaled $54 million, an increase of $10 million over 1997.

As of June 1998, seven countries were potentially subject to the application of Article 6.B: Bolivia, Cuba, Dominican Republic, Ecuador, Grenada, Nicaragua, and Peru.

The Director was gratified that the countries were clearly taking their financial responsibilities to the Organization seriously and that six Member States had already made their full contribution for 1998. He acknowledged the commitment of the Member States in arrears to fulfill the terms of their payment plans and commended Cuba, in particular, for its efforts, despite the severe economic constraints that country faced. He emphasized that the Organization would continue to work with the countries with a view to ensuring that all would be able to vote at the Pan American Sanitary Conference, the most important meeting in the life of the Organization.

The Committee adopted Resolution CE122.R1.

Financial Report of the Director and Report of the External Auditor for 1996-1997 (Official Document 286)

Mr. Matthews outlined the content of the Financial Report of the Director and Report of the External Auditor for 1996-1997, noting that the report reflected careful financial management and progress in strengthening the Organization's financial position in 1997. Income for 1997 had exceeded expenditures by $8.5 million in the regular budget, which had increased the working capital fund balance to $8.6 million. Cash in banks and investments had increased 55% between 31 December 1995 and 31 December 1997, to $139.6 million. Total 1996-1997 expenditures had decreased $24.2 million with respect to the 1994-1995 biennium. However, the percentage of current quota assessments collected during 1996-1997 was 69%, which was lower than the three previous biennia (73%, 80%, and 71%, respectively). With regard to extrabudgetary funds, $103.2 million had been received on behalf of trust fund projects during the 1996-1997 biennium, an amount equivalent to 50% of the PAHO regular budget.

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